ArticleRisk management and healthcare policy2026
Barriers to Lean & Safety Management Implementation in Primary Care Settings: Insights from an Unsuccessful Case.
Article in Risk management and healthcare policy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Primary care is widely recognized as a cornerstone of universal health coverage, providing high-quality care in community-based settings. Structured managerial approaches such as Lean & Safety Management (L&SM) can support quality improvement in healthcare by reducing waste and risk and enhancing patient safety and satisfaction. However, evidence on the sustainable implementation of L&SM-defined as the ability to complete implementation and maintain improvements over time-remains limited in primary care. This study aims to identify key challenges affecting the sustainability of L&SM implementation in community healthcare centers. Methods: An unsuccessful L&SM implementation was analyzed through an in-depth case study of an Integrated Family Medicine Centre in Italy. The project, based on the DMAIC framework, was discontinued after the Define phase. A structured three-step methodology was adopted: 1) selection of a failed implementation case using predefined suitability criteria; 2) identification of implementation barriers through a systematic assessment of Critical Success Factors for sustainable Lean and Safety implementation adapted from the literature; and 3) validation of findings and exploration of corrective actions through a stakeholders focus group. Results: The analysis identified multiple barriers that contributed to implementation failure. These barriers were synthesized into three interrelated themes: organizational readiness, stakeholder ownership and engagement, and governance fragmentation. Together, these factors limited coordination, reduced commitment to improvement activities, and hindered the sustainability of the implementation process. Conclusion: Sustainable L&SM implementation in primary care requires organizational readiness, committed leadership, stakeholder engagement, adequate training, and robust data infrastructure. Addressing these factors may improve the successful adoption and long-term sustainability of quality improvement initiatives in community-based settings.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.